Simvastatin therapy in higher dosages deteriorates bone quality: Consistent evidence from population-wide patient data and interventional mouse studies.

BACKGROUND: Combining mouse experiments with big data analysis of the Austrian population, we investigated the association between high-dose statin treatment and bone quality. METHODS: The bone microarchitecture of the femur and vertebral body L4 was measured in male and ovariectomized female mice on a high-fat diet containing simvastatin (1.2 g/kg). A sex-specific matched big data analysis of Austrian health insurance claims using multiple logistic regression models was conducted (simvastatin 60-80 mg/day vs. controls; males: n = 138,666; females: n = 155,055). RESULTS: High-dose simvastatin impaired bone quality in male and ovariectomized mice. In the trabecular femur, simvastatin reduced bone volume (µm3: ♂, 213 ± 15 vs. 131 ± 7, p < 0.0001; ♀, 66 ± 7 vs. 44 ± 5, p = 0.02) and trabecular number (1/mm: ♂, 1.88 ± 0.09 vs. 1.27 ± 0.06, p < 0.0001; ♀, 0.60 ± 0.05 vs. 0.43 ± 0.04, p = 0.01). In the cortical femur, bone volume (mm3: ♂, 1.44 ± 0.03 vs. 1.34 ± 0.03, p = 0.009; ♀, 1.33 ± 0.03 vs. 1.12 ± 0.03, p = 0.0002) and cortical thickness were impaired (µm: ♂, 211 ± 4 vs. 189 ± 4, p = 0.0004; ♀, 193 ± 3 vs. 169 ± 3, p < 0.0001). Similar impairments were found in vertebral body L4. Simvastatin-induced changes in weight or glucose metabolism were excluded as mediators of deteriorations in bone quality. Results from mice were supported by a matched cohort analysis showing an association between high-dose simvastatin and increased risk of osteoporosis in patients (♂, OR: 5.91, CI: 3.17-10.99, p < 0.001; ♀, OR: 4.16, CI: 2.92-5.92, p < 0.001). CONCLUSION: High-dose simvastatin dramatically reduces bone quality in obese male and ovariectomized female mice, suggesting that direct drug action accounts for the association between high dosage and increased risk of osteoporosis as observed in comparable human cohorts. The underlying pathophysiological mechanisms behind this relationship are presently unknown and require further investigation.

A systematic approach to analyse the impact of farm-profiles on bovine health.

In this study we present systematic framework to analyse the impact of farm profiles as combinations of environmental conditions and management practices on common diseases in dairy cattle. The data used for this secondary data analysis includes observational data from 166 farms with a total of 5828 dairy cows. Each farm is characterised by features from five categories: husbandry, feeding, environmental conditions, housing, and milking systems. We combine dimension reduction with clustering techniques to identify groups of similar farm attributes, which we refer to as farm profiles. A statistical analysis of the farm profiles and their related disease risks is carried out to study the associations between disease risk, farm membership to a specific cluster as well as variables that characterise a given cluster by means of a multivariate regression model. The disease risks of five different farm profiles arise as the result of complex interactions between environmental conditions and farm management practices. We confirm previously documented relationships between diseases, feeding and husbandry. Furthermore, novel associations between housing and milking systems and specific disorders like lameness and ketosis have been discovered. Our approach contributes to paving a way towards a more holistic and data-driven understanding of bovine health and its risk factors.

A look into the future of the COVID-19 pandemic in Europe: an expert consultation.

How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.

Quantification of diabetes comorbidity risks across life using nation-wide big claims data.

Despite substantial progress in the study of diabetes, important questions remain about its comorbidities and clinical heterogeneity. To explore these issues, we develop a framework allowing for the first time to quantify nation-wide risks and their age- and sex-dependence for each diabetic comorbidity, and whether the association may be consequential or causal, in a sample of almost two million patients. This study is equivalent to nearly 40,000 single clinical measurements. We confirm the highly controversial relation of increased risk for Parkinson's disease in diabetics, using a 10 times larger cohort than previous studies on this relation. Detection of type 1 diabetes leads detection of depressions, whereas there is a strong comorbidity relation between type 2 diabetes and schizophrenia, suggesting similar pathogenic or medication-related mechanisms. We find significant sex differences in the progression of, for instance, sleep disorders and congestive heart failure in diabetic patients. Hypertension is a highly sex-sensitive comorbidity with females being at lower risk during fertile age, but at higher risk otherwise. These results may be useful to improve screening practices in the general population. Clinical management of diabetes must address age- and sex-dependence of multiple comorbid conditions.

Instrumentational complexity of music genres and why simplicity sells.

Listening habits are strongly influenced by two opposing aspects, the desire for variety and the demand for uniformity in music. In this work we quantify these two notions in terms of instrumentation and production technologies that are typically involved in crafting popular music. We assign an 'instrumentational complexity value' to each music style. Styles of low instrumentational complexity tend to have generic instrumentations that can also be found in many other styles. Styles of high complexity, on the other hand, are characterized by a large variety of instruments that can only be found in a small number of other styles. To model these results we propose a simple stochastic model that explicitly takes the capabilities of artists into account. We find empirical evidence that individual styles show dramatic changes in their instrumentational complexity over the last fifty years. 'New wave' or 'disco' quickly climbed towards higher complexity in the 70s and fell back to low complexity levels shortly afterwards, whereas styles like 'folk rock' remained at constant high instrumentational complexity levels. We show that changes in the instrumentational complexity of a style are related to its number of sales and to the number of artists contributing to that style. As a style attracts a growing number of artists, its instrumentational variety usually increases. At the same time the instrumentational uniformity of a style decreases, i.e. a unique stylistic and increasingly complex expression pattern emerges. In contrast, album sales of a given style typically increase with decreasing instrumentational complexity. This can be interpreted as music becoming increasingly formulaic in terms of instrumentation once commercial or mainstream success sets in.

Effects of potato-derived protease inhibitors on perianal dermatitis after colon resection for long-segment Hirschsprung's disease.

BACKGROUND: After resection of long-segment Hirschsprung's disease, severe perianal dermatitis (SPAD) may occur because of high stool frequency and elevated concentrations of fecal pancreatic proteases. We investigated prospectively the effect of potato-derived protease inhibitors (PPI) on skin conditions in children with postoperative SPAD. METHODS: Four children (aged 12 to 24 months) with therapy-resistant SPAD after transanal endorectal pull-through for long-segment Hirschsprung's disease received topical PPI (1% in 20% zinc ointment) with each diaper-change. Parents noted down a subjective dermatitis score daily. Photo documentation and outpatient visits were made to assess the treatment results. RESULTS: No adverse effects were observed after treatment with PPI. A remarkable improvement of the dermatitis in 3 of the 4 patients as well as improvements in pain and sleep disorders were observed during the PPI-treatment course. CONCLUSION: The results of the study suggest that PPI may reduce otherwise intractable protease-induced skin irritation in infants.